Healthcare Provider Details

I. General information

NPI: 1457575540
Provider Name (Legal Business Name): SHATKIN CARDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9901 SEAPOINTE BLVD
WILDWOOD CREST NJ
08260-6203
US

IV. Provider business mailing address

6083 WILDCAT RUN
WEST PALM BEACH FL
33412-3006
US

V. Phone/Fax

Practice location:
  • Phone: 609-774-5372
  • Fax:
Mailing address:
  • Phone: 609-774-5372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA52095
License Number StateNJ

VIII. Authorized Official

Name: DR. BENNETT SHATKIN
Title or Position: PHYSICIAN
Credential: MD
Phone: 609-774-5372